chapter 16 abnormal psych

personality

set of uniquely expressed charateristics that influence our behaviors, emotions, thoughts and interactions

ppl who think they have extrasensory abilities are not necessarily

suffering from schizotypal personality disorder. in fact 73% of americans belive in some form of the paranormal or occult-ESP, astrology, ghosts, communication w dead or psychics

treatments for antisocial

typically ineffective obstacles: lack of conscience, desire to change or respect for therapy -most are forced to participate by employer, school, law, or come to attention when develop another psychological disorder -cog- get them to think about moral issues and about needs of other ppl number of hospitals and prisons have tried to create a therapeutic community for ppl w disorder, a structured environment that teaches responsibility toward others -psychotropic meds, particularly atypical antipsychotic drugs have been used , may help reduce certain features of disorder, but systematic studies of claims are still needed

48% of ppl in us consider themselves o be shy to some degree

-in recent yrs rock music has been strongly influenced by stars w extremely shy reticent demeanors the alternative rock band my bloody valentine often plays w their backs to the audience and spearheaded an influential pop movement called shoe gaze based on their tendency to look away or at the floor during shows -in early shows, indie rock musician sufjan stevens would nervously applaud his audience when they clapped for him - for many of her initial concerts, folk singer cat power (chan marshall) would not look at the audience and would weep or run offstage during shows -meg white, drummer for the two piece rock band white stripes appeared uncomfortable and quiet both onstage and during rarely given interviews, the group disbanded after acute anxiety forced her to cancel 2007 tour

treatments for borderline

-pscyhotherapy- some degree of improvement for ppl, difficult for a therapist to strike a balance between empathizing w borderline's dependency and anger and challenging his or her way of thinking emotionally draining, so some therapists wont treat them the fluctuating interpersonal attitude of them makes it hard to have collaborative working relationships w them these ppl may violate client therapist relationship lines - traditional pscyhoanalysis has not been affective they often think therapists' reserved style and encouragement of free association is suggesting disinterest and abandonment can have difficulty tolerating interpretations made by therapists as attacks -contemporary pscyhodynamic- like relational psychoanalytic therapy in which therapists take a more suportive and egalitarian posture has been more effective than traditional provides empathetic setting where borderline ppl can explore their unconsciouss conflicts and pay particular attention to their central relationship disturbance, poor sense of self and pervasive loneliness and emptiness sometimes helps reduce suicides, self harm behaviors, and number of hospitalizations and bring at least some improvement to borderline ppl -dialectical behavior therapy (DBT) integrative treatment of choice linehan grows from cog beh model applies alot of the same cognitive and behavioral techniques that are applied to other disorders like homework, psychoeducation, teaching social and other skills, modeling by the therapist, clear goal setting, reinforcements for appropriate behavior, ongoing assessment of children's behaviors and treatment progress, and collaborative examinations by the client and therapist of the client's way of thinking also borrows from humanistic and contemp psychodynamic approaches placing client therapist relationship itself at he center of treatmet interactions, to make sure there are appropriate boundaries and providing an environment of acceptance and validation of the client DBT therapists regularly empathize w their clients w emotional turmoil they are experiencing, local the truths of client's complaints or demands, and examine alternative ways for them to address valid needs often supplemented by clients participation in social skill building groups where they practice new ways of relating to other ppl in a safe environment and receive validation and support from other ppl more research support on this than other treatment for borderline ppl are more able to tolerate stress, develop new more appropriate social skills, respond more effectively to life situations, develop a more stable identity sig fewer suicidal behaviors and require fewer hospitalizations more likely to remain in treatment, and report less anger more social gratification, improved work performance, and reductions in substance abuse -antidepressant, antibipolar, antianxiety and antipsychotic drugs have helped calm emotional and aggressive storms of some ppl use of drugs is controversial bc of number of suicide attempts many adjust or discontinue their meds without consulting clinicians belief that psychotropic drug treatment should be used largely as an adjunct to psychotherapy approaches and many clients seem to benefit from a combo of psychotherapy and drug therapy

explain narcissism

-psychodynamic have more theories than other approaches begin w cold rejecting parents spend their lives defending against feeling unsatisfied, rejected, unworthy, ashamed, and wary of the world repeatedly telling themselves they are actually perfect and desirable seek admiration from others object relations theorists (psychodynamic theorists who emphasize relationships) interpret grandiose self image as a way for these ppl to convince themselves they are totally self sufficient and without need of warm relationships w parents or anyone else children who are abused or who lose parents through adoption, divorce or death are at particular risk for the later development of disorder ppl w disorder do indeed earn relatively high shame and rejection scores on various scales and believe that other ppl are basically unavailable to them -cog beh may develop when ppl are treated too positively rather than too negatively early in life hold that certain children acquire a superior and grandiose attitude when their admiring or doting parents teach them to overvalue their self worth, repeatedly rewarding them for minor accomplishments or for no accomplishments at all -sociocultural links disorder and eras of narcissism in society suggest family values and social ideals in certain societies periodically break down, producing generations of young ppl who are self centered materialistic and have short attention spans westernized cultures encourage self expression, individualism, and competitiveness, are likely considered to produce such generations of narcissists study-respondents from us had highest narcissism scores followed by europe, canada, asia, and middle east

explaining histrionic

-psychodynamic perspective to explain cases of hysteria originally, so strong interest in this disorder believe that as children, ppl had cold and controlling parents who left them feeling unloved and afraid of abandonment to defend against fears of loss, children learned to behave dramatically inventing crises that would require other ppl to act protectively -cog look at lack of substance and extreme suggestibility they have less and less interested in knowing about te world at large bc they are so self focused and emotional no detailed mems of what they never learned, must rely on hunches or on other ppl to provide them w direction in life holds a general assumption that they are helpless to car for themselves, so they seek out others who will meet their needs -sociocultural particularly multicultural can be produced in part by cultural norms and expectations, until recently our society encouraged girls to hold onto childhood and dependency as they grew up and the vain dramatic selfish behavior of these ppl may be an exaggeration of femininity as our culture once defined it less often diagnosed in asian and other cultures that discourage oversexualization and more often in hispanic and latin cultures that are more tolerant of overt sexualization have not investigated this claim

explain dependent

-psychodynamic very similar explanation to those w depression unresolved conflicts during oral stage of development can give rise to a lifelong need for nurturance heightening the likelihood of a dependent personality diosrder object relations say early parental loss or rejection may prevent normal experiences of attachment and separation leaving children w fears of abandonment that persist throughout their lives others say many parents of ppl w this were overinvolved and overprotective increasing child's dependency insecurity and separation anxiety -beh say parents of ppl w this unintentionally rewarded children's clinging and loyal behavior and punishing acts of independence maybe through withdrawal of love or some parents own dependent behaviors served as models for children - cog say 2 maladaptive attitudes help to produce and maintain disorder 1- i am inadequate and helpless to deal w world 2- i must find a person to provide protection so i can cope dichotomous (black and white) thinking may play key role- if i am to be dependent i must be completely helpless or if i am to be independent i must be alone thinking like this prevents sufferers from making efforts to be autonomous

explanation of antisocial

-psychodynamic- begins w absence of parental love during infancy, leading to a lack of basic trust some children (ones who develop antisocial disorder) respond to the early inadequacies by becoming emotionally distant, they bond w others through use of power and destructiveness found that antisocial ppl are more likely than others to have had significant stress in their childhoods particularly w family poverty, family violence, child abuse, parental conflict or divorce -behavioral- learned through modeling or imitation higher rate of antisocial found in parents of ppl w disorder parents unintentionally teach antisocial behavior by rewarding children's aggressive behaviors/ when child misbehaves or becomes violent in reaction to parent's requests or orders, the parents may give in to restore peace, which could teach the child to be stubborn and even violent -cog- hold attitudes that trivialize the importance of other ppl's needs, such philosophies of life may be much more common in our society than ppl realize genuine difficulty recognizing points of view or feelings other than their own -biological- may play important role antisocial ppl, particularly highly impulsive and aggressive, have lower serotonin activity than others, linked to this behavior in other studies too studies say display deficient functioning in frontal lobes, particularly prefrontal cortex which helps ppl plan and execute realistic strategies and to have personal characteristics such as sympathy, judgment and empathy, all antisocial behaviors research found that antisocial ppl often feel less anxiety than other ppl so lack a key ingredient for learning, they have trouble learning from neg life experiences or tuning in to the emotional cues of others/ antisocial ppl respond to warnings or expectations of stress w low brain and bodily arousal such as slow autonomic arousal and slow eeg waves, bc of low arousal they tune out threatening or emotional situations easily, and are unaffected by them argued that antisocial ppl are more likely than other ppl to take risks and seek thrills due to physical underarousal, may meet an underlying biological need for more excitement and arousal, antisocial and sensation seeking behavior go hand in hand

explaining borderline

-psychodynamic-early parental relationships bc fear of abandonment object relations theorists say that an early lack of acceptance by parents may lead to a loss of self esteem, increased dependence and an inability to cope w separation research is consistent w early childhoods of borderline ppl when children, parents rejected them or neglected them verbally abused them or behaved inappropriately marked by multiple parent substitutes, divorce, death, or traumas such as physical or sexual abuse early sexual abuse is a common contributor to development of disorder children who are abused are 4x more likely to develop disorder many ppl who are abused physically, sexually or psychologically do not go on to develop this disorder -biological- overly reactive amygdala (closely tied to fear and other neg emotions) , an underactive prefrontal cortex ( brain region linked to planning self control and decision making) ppl w disorder who are particularly impulsive- those who attempt suicide or are very aggressive toward others have lower brain serotonin activity lower activity could be linked to abnormality of 5htt gene (serotonin transporter gene) which has also been linked to major depressive disorder, suicide, aggression, and impulsivity close relatives are 5x more likely to have same disorder -biosocial theory- results from combo of internal forces (like difficulty identifying and controlling one's emotions, social skill deficits, abnormal neurotransmitter reactions) and external forces (like environment in which a childs emotions are punished ignored trivialized or disregarded) parents can misinterpret their childs intense emotions as exaggerations or attempts at manipulation rather than as serious expressions of a n unsettled internal state if they have intrinsic difficulty identifying and controlling their emotions and if their parents teach them to ignore their intense feelings, they may never learn how to properly recognize and control their emotional responses biosocial theory is similar to explanation for eating disorders, parents who dont respond accurately to childrens internal cues may never learn to identify cues of hunger, may lead to eating disorder, many borderlines have eating disorder -sociocultural- emerge in cultures that change rapidly , when a culture loses stability it inevitably leaves many of its members w problems of identity, sense of emptiness, high anxiety, and fears of abandonment family units may come apart leaving ppl w little sense of belonging changes of these kinds may explain growing reports for borderline disorder LOOK AT TABLE ON PG 536 FOR COMPARISONS

19% of ppl w severe personality disorders who are racial or ethnic minority group members 59% of ppl w severe personality disorders are male 6% of ppl w severe personality disorders are unemployed

23% of ppl w severe personality disorders have never married 10% of impoverished pl w borderline personality disorder 3% of wealthy ppl have borderline personality disorder

dsm5 has 10 disorders

3 groups (clusters) odd or eccentric behavior ( paranoid, schizoid, and schizotypal personality disorder) dramatic behavior ( antisocial, borderline, histrionic, and narcissistic) high degree of anxiety (avoidant, dependent, and obsessive compulsive) characterized by a group of problematic personality symptoms categorical approach- the dsm's listing of 10 distinct personality disorders, assumes that problematic personality traist are either present or absent in ppl, a personality disorder is either displayed or not displayed by a person, a person who suffers from a personality disorder is not markedly troubled by personality traits outside of that disorder overlap so hard to distinguish one disorder from another , some have more than one lack of agreement has raised serious questions about the validity (accuracy) and reliability (consistency) of 10 dsm categories challenge categorical approach- say personality disorders differ more in degree than in type of dysfunction and should instead be classified by the severity of personality traits rather than by the presence or absence of specific raits, a procedure called dimensional approach each trait is seen as varying along a continuum extending from nonproblematic to extremely problematic , display extreme degrees of problematic traits in ppl w personality disorders (ones not commonly found in general public) more enthusiasm for dimensional approach proposed a largely dimensional system that would allow many additional kinds of personality problems to be classified as personality disorders and would require clinicians to assess the severity of each problematic trait exhibited by a person who recieves a diagnosis of personality disorder but raised concern and criticism so dsm 5 framers stuck w categorical approach dsm5 describes alternative dimensional approach for the future clear that diagnosises are assigned too often, only maladaptive distressful, and inflexible ones are considered disorders PG 520 FOR DSM

15% of drivers yell out obscenities when upset by other motorists 14% have shouted at or had a honking match w another driver in the past year 7% give the finger when upset by other drivers 7% shake their fists when upset by other drivers 2% have had a fist fight w another driver

67% of young adult drivers consider themselves aggressive drivers 30% of elderly drivers consider themselves aggressive drivers 59% of drivers w children say they are likely to respond aggressively to a traffic altercation 45% of drivers without children say they are likely to respond aggressively to a traffic altercation 66% of all annual traffic fatalities are caused by aggressive driving

selfies narcissitic?

90% of teens have posted a photo of themselves online word of the year in 2013 psychologists think taking selfies is form of narcissistic behavior or can view it more positively -many sociocultural theorists see a link between narcissism and eras of narcissism in society, suggest that social values in society break down periodically producing generations of self centered materialistic youth, aka selfie generation not supported by research no relationship between number of selfies posted w how high they score on narcissism scale does not mean they are harmless though, near reflexive instinct to photograph oneself may limit deeper engagements w the environment or experiencing events to their fullest , ppl that post alot of selfies are often seeking external validation of their self worth, even if that pursuit may not rise to level of clinical narcissism too many selfies ay alienate those who view the poster's social media profile ppl often take negative view of friends and fam who excessively post photos to facebook -belief that concerns w criticisms of selfie movement have been overstated tech enabled self expression confusing to individuals of predigital generation can enhance explorations of identity, help identify one's interests, develop artistic expression, help ppl craft a meaningful narrative of their life experiences, even reflect more realistic body images (selfies w/o makeup) selfies serve as springboard to discuss issues that clients are reluctant to broach on their own in therapy mixed grades from psychs and practitioners ruler of denmark had his portrait painted at least 70 times by the same artist carl pilo

borderline personality disorder

a personality disorder characterized by repeated instability in interpersonal relationships, self image, and mood and by impulsive behavior relationships are very unstable swing in and out of very depressive, anxious, and irritable states that last anywhere from a few hours to a few days or more emotions always in conflict w the world around them/prone to bouts of anger, sometimes leading to physical aggression and violence, often direct impulsive anger inward and inflict bodily harm on themselves also many troubled by deep feelings of emptiness complex and one of more common conditions in clinical practice many ppl who go to emergency rooms are ppl w this disorder who intentionally hurt themselves impulsive, self destructive activities from alcohol to substance abuse to delinquency to unsafe sex, and reckless driving self injurious or self mutilation behaviors such as cutting or burning themselves or banging their heads behavios cause immense physical suffering but feel physical discomfort offers relief from their emotional suffering, distraction from emotional or interpersonal upsets snapping them out of an emotional overload hurt themselves to deal w their chronic feelings of emptiness, boredom, and identity confusion, scars prove evidence of emotional distress borderline patterns are more severe among those who injure themselves suicidal threats and actions are common 75% of ppl w borderline personality disorder attempt suicide at least once in their life, 10% actually commit suicide enter clinical treatment by emergency room after suicide attempt is common form intense conflict ridden relationships in which their feelings are not necessarily shared by the other person. idealize another person's qualities and abilities after just a brief first encounter may violate boundaries of relationships, think in black and white terms they quickly feel rejected and become furious when their expectations are not met, yet they remain very attached to the relationships recurrent fears of impending abandonment and frequently engage in frantic efforts to avoid real or imagined separations from important ppl in their lives cut themselves or carry out self destructive acts to prevent partners from leaving have dramatic identity shifts unstable sense of self, goals, aspirations, friends, and even sexual orientation may shift rapidly sense of dissociation or detachment from their own thoughts or bodies may have no sense of self at times , leaving them to feel empty 5.9% of adult pop 75% are women, course of disorder varies from each person most commonly a persons instability and risk of suicide peak during young adulthood then gradually wane w advancing age chaotic and unstable relationships so interferes w job performance even more than other personality disorders

paranoid personality disorder

a personality disorder marked by a pattern of distrust and suspiciousness of others everyone out to get them, shun close relationships trust in own ideas and abilities can be excessive on guard and cautious and sees threats everywhere, expect to be targets of some trickery hidden meanings, usually belittling or threatening, in everything study- more likely to read hostile intentions into the actions of others, more often chose anger as the appropriate role-play response quick to challenge the loyalty or trustworthiness of acquaintances, ppl w paranoid personality remain cold and distant suspicions are normally not delusional the idease are not so bizarre or firmly held as to clearly remove the individuals from reality critical of weakness and fault in others esp at work unable to recognize own mistakes, extremely sensitive to criticism blame others for things that go wrong in their lives, bear grudges 4.4% of adults have this, more common in men than women women avoid confiding in anyone, men example as persistant questioning in wifes faithfulness explaining: little research psychodynamic theories (oldest of explanations) trace the pattern to early interactions w demanding parents, particularly distant, rigid fathers and overcontrolling, rejecting mothers/ some ppl come to view their environment as hostile as a result of their paren'ts perisitently unreasonable demands, must always be on high alert bc cant trust others, and are likely to develop feelings of extreme anger , project feelings onto others, feel increasingly persecuted as result cognitive-broad maladaptive assumptions, people are evil and evil will attack you if given the chance biological- genetic causes study- if one win was excessively suspicious the other had an increased likelihood to be suspicious, may be cause of common environmental experiences treatment: typically dont see themselves as needing help, few come to treatment willingly, many who are in treatment view role of patient as inferior and distrust and rebel against their therapists, therapy has limited effects and moves very slowly object relations therapists- psychodynamic therapists who give center stage to relationships- try to see the patients anger and work on what they view as his or her deep wish for a satisfying relationship selftherapists- psychodynamics who focus on need for a healthy and unified self- try to help clients reestablish self cohesion (unified personality) which they believe has been lost in the person's continuing negative focus on others cog and beh- have been used and often combined into an integrated cog beh approach, beh side helps clients to master anxiety-reduction techniques and to improve their skills at solving interpersonal problems, cog side guides the clients to develop more realistic interpretations of other ppl's words and actions and to become more aware of other ppl's points of view antipsychotic drug therapy seems to be of limited helps

personality disorder- trait specified approach (PDTS)

alternative to big 5 for revision of dsm5 a personality disorder currently undergoing study for possible inclusion in a future revision of dsm 5, ppl would recieve diagnosis if they had significant impairment in their functioning as a result of one or more very problematic traits list problematic traits and rate severity of impairment by them negative affectivity: ppl who experience neg emotions frequently and intensely one or more of : emotional lability (unstable emotions), anxiousness, separation insecurity, perservation (repetition of certain behaviors despite repeated failures), submissiveness, hostility, depressivity, suspiciousness, and strong emotional reactions (overreactions to emotionally arousing sitations) detachment: withdraw from other ppl and social interactions have restricted emotional reactivity (little reaction to emoionally arousing situations), depressivity, suspiciousness, withdrawla, anhedonia (inability to feel pleasure or take interest in things), intimacy avoidance depressivity and suspiciousness also found in neg affectivity antagonism: behave in ways that put them at odds w other ppl hostility (also found in neg affect), manipulativeness, deceitfulness, grandiosity, attention seeking, callousness, hostility disinhibition: behave impulsively without reflecting on potential future consequences irresponsibility, impulsivity, distractibility, risk taking, imperfection/disorganization psychoticism: unusual and bizarre experiences unusual beliefs and experiences, eccentricity, cog and perceptual dysregulation (odd thought processes and sensory experiences)

personality disorder

an enduring, rigid pattern of inner experience and outward behavior that repeatedl impairs a person's sense of self, emotional experiences, goals, capacity for empather and or capacity for intimacy much more extreme and dysfunctional personality traits than normal ppl sig problems and psychological pain for themselves or others

dramatic personality disorders

antisocial, borderline, histrionic, narcissistic dramatic emotional or erratic makes it impossible for them to have relationships that are truly giving and satisfying more commonly diagnosed than others antisocial and borderline have alot of studies on tem bc they create so many problems for other ppl causes are not well understood treatments are ineffective to moderately effective

explaining avoidant

assume same causes of anxiety disorders- early trauams, conditioned fears, upsetting beliefs, or biochemical abnormalities research has not yet tied the personality disorder directly to anxiety disorder -pscyodynamic focus on general sense of shame that these ppl feel trace shame to childhood experiences such as early bowel and bladder accidents or if parents repeatedly punished or ridiculed a child for having these accidents the ppl would develop neg self image, may lead to child feeling unlovable throughout life and distrusting the love of others -cog believe harsh criticism and rejection in early childhood may lead certain ppl to assume that others in the environment will always judge them negatively come to expect rejection, misinterpretat reactions of others to fit that expectation and discount positive feedback and generally fear social involvements when asked to recall childhood their descriptions supported psycho and cog theories bc they felt criticized rejected and isolated receiving little encouragement from their parents and experiencing few displays of parental love or pride -behavioral suggest that they typically fail to develop normal social skills, which helps maintain disorder social skill deficits have been found in these ppl deficits first develop as a result of individuals avoiding so many social situations

anxious personality disorders

avoidant, dependent, obsessive compulsive personality disoders anxious and fearful behavior similar to anxiety and depressive disorders but no direct links between this cluster and those disorders research for explanations are limited treatments for disorders seems to be modestly to moderately helpful (much better than other personality disorders)

big 5

basic structure of personality may consist of 5 supertraits or factors: neuroticism, extroversion, openness to experiences, agreeableness, and conscientiousness many consist of subfators (anxiety and hostility for neuroticism, optimism and friendliness for extroversion) everyones personality can be summarized by a combo of these supertraits high medium or low of each it would be best to describe all ppl w personality disorders as being high low or in between on the five supertraits and to drop the use of personality disorder categories altogether ex avoidant may have high neuroticism, medium agreeableness and conscientiousness, and very low degrees of extroversion and openness to new experiences ex narcissism has high neuroticism and extroversion, medium conscientiousness and openness to new experiences, and very low degree of agreeableness could be in the next world health organizations internation classification of diseases (ICD)

avoidant personality disorder

characterized by consistent discomfort and restraint in social situations, overwhelming feelings of inadequacy, and extreme sensitivity to neg evaluation fearful of being rejected that they give no one opportunity to reject them (or accept them) actively avoid occasions for social contact not bad social skills but more dread of criticism disapproval or rejection timid and hesitant about social situations afraid of saying something foolish or embarrassing themselves by blushing or acting nervous even in intimate relationships they are very careful, afraid of being shamed or ridiculed believe themselves to be unappealing or inferior to others exaggerate potential difficulties so seldom take risks or try out new activities, have few or no close friends yearn for intimate relationships and frequently feel depressed and lonely, some develop inner world of fantasy and imagination similar to social anxiety disorder, many w one experience the other / similarities of fear of humiliation and low confidence / key difference is that ppl w social anxiety fear social circumstances, while ppl w personality disorder fear close social relationships / others think they reflect the same psychopathology and should be combined 2.4% of aduls men as frequent as women many children and teenagers are painfully shy and avoid other ppl but this is usually normal part of their development

schizotypal personality disorder

characterized by extreme discomfort in close relationships, very odd patterns of thinking and perceiving and behavioral eccentricities anxious around others, seek isolation, few close friends, some feel intensely lonely, more severe than paranoid and schizoid noticeably disturbed ideas of reference- beliefs that unrelated events pertain to them in some important way bodily illusions- sensing external force or presence a number see themselves w having special extrasensory abilities, and some believe that they have magical control over others eccentricities- repeatedly arranging cans to align their labels, organizing closets extensively, or wearing an odd assortment of clothing emotions are inappropriate flat and humorless difficult to keep their attention focused, convos are typically digressive and vague sometimes w loose associations drift aimlessly, lead an idle unproductive life choose undemanding jobs in which they can work below their capacity and are not required to interact w other ppl 3.9% of adults, slightly more males explain: similar factors as schiz bc relation to schiz symptoms -schizotypal symptoms like schizophrenic's, linked to family conflicts and to psychological disorders in parents, defects in attention and short term memory may contribute like they do to schiz also ppl with either disorder perform poorly on backward masking- lab test of attention that requires a person to identify a visual stimulus immediately after a previous stimulus has flashed on and off screen, have hard time shutting out the first stimulus in order to focus on the second linked to same biological factors as schiz, like high activity in neurotransmitter dopamine, enlarged brain ventricles, smaller temporal lobes, loss of gray matter, that may have genetic base - also been linked to disorders of mood, more than half also suffer from major depressive disorder at some point in their lives, relatives of ppl w depression have a higher than usual rate , so not exclusively tied to schiz treatments: need to help reconnect with the world and recognize the limits of their thinking and their powers, therapists must try to set clear limits ( ex requiring punctuality, work on helping the clients recognize where their views end and those of therapists begin, want to increase positive social contacts, ease loneliness, reduce overstimulation, help become more aware of person feelings, hard to get to therapy, -cog beh- cog interventions to teach clients to evaluate teir unusual thoughts or perceptions objectiely and to ignore the inappropriate ones ex therapist may keep track of clients' odd or magical predictions and later point out their inaccuracy ex when clients begin to digress when speaking, they ask them to sum up what they wanted to say beh methods like speech lessons, social skills training, tips on appropriate dress and manners, have sometimes helped clients learn to blend in better w and be more comfortable around others -antispsychotic drugs have been given to ppl w schizotypal bc of the disorder's similarity to schiz, low doses of drugs help some ppl usually by reducing certain thought problems

dependent personality disorder

characterized by pattern of clinging and obedience, fear of separation of ppl in close relationships w them, and an ongoing need to be taken care of cannot make smallest decision for themselves bc rely on others so much normal to depend on others but not when need assistance w simplest matters and have extreme feelings of inadequacy and helplessness afraid they cannot care for themselves they cling deperately to friends and relatives have difficulty initiating relationships for avoidant, dependent have difficulty w separation feel completely helpless and devastated when a close relationship ends and quickly seek out another relationship to fill the void many cling persistantly to relationships w partners who physically of psychologically abuse them lacking confidence in own ability and judgement seldom disagree w others and allow even important decisions to be made for them ex where to live, what job, what neighbors to not be friends w overly sensitive to disapproval and keep trying to meet other ppl's wishes and expectations even if it means volunteering for unpleasant or demeaning tasks bc they fear rejection most feel distressed, lonely, and sad, most dislike themselves most at risk for depressive, anxiety, and eating disorders fear of separation and feelings of helplessness may leave them prone to suicidal thoughts esp when they believe a relationship is about to end 1% of pop used to believe more women but disorder is just as common in men

treatment for avoidant

come to therapy in hope of finding acceptance and affection keeping them in treatment may be a challenge bc they will start to avoid sessions often distrust therapy and start to fear his or her rejection key task of therapy is to gain the person's trust - tend to treat ppl similarly as they treat social anxiety ppl and other anxiety disorders approaches have modest success -psychodynamic help clients recognize and resolve the unconscious conflicts that may be operating -cog help them change their distressing beliefs and thoughts, carry on it the face of painful emotions, and improve their self image -behavioral ppl gradually increase their social contacts -group therapies have added advantage of providing clients w practice in social interactions ( esp in cog and beh principles) -antianxiety and antidepressant drugs are sometimes useful in reducing the social anxiety of ppl w the disorder, symptoms return when medication is stopped

comorbidity

common for a personality disorder to also suffer from another disorder ex avoidant personality and social anxiety disorders / predispositions or biological factor for predisposition to both presence of a personality disorder complicates a person's chances for a successful recovery from other psychological problems

multicultural factors, research neglect

dsm5 personality disorder must " deviate markedly from expectations of individuals culture" striking how little multicultual reserach has been conducted clinical theorists have suspicions but little compelling evidence that there are cultural dif in this realm or that dif are important to field's understanding and treatment of personality disorders lack of research is special concern for borderline bc theorists are convinced that gender and other cultural dif may be particularly important in both the development and diagnosis of this disorder 75% of ppl are female w borderline maybe more biologically prone, bias, or dif may instead be reflection of extraordinary traumas to which many women face as children ( emotional trauma, victimization, violence, abuse, sexual abuse) which can be prerequisits to development of disorder women in our society are subjected to such experiences and so disorder should maybe be special form of posttraumatic stress disorder alternative explanaitons like these remain untested w no treatments available multicultural theorists believe that disorder may actually be a reaction of persistant feelings of marginality, powerlessness, and social failure so may be subject more to social inequities (sexism, racism, homophobia) than to psych factors multicultural studies: -disproportionately more hispanic american clients qualified for diagnosis of borderline than whites or blacks (more likely to get it, why?) - may be perfectly acceptable traits and behaviors in some cultures, ex puerto rican have men that are expected to have strong emotions like anger aggression and sexual attraction (could this account for higher rates w hispanics? and explain how hispanic women and men have same amounts of the disorder compared to 3-1 women to men in other cultural groups?) need more research

egoists-person concerned primarily w his or her own interests

egotist- has inflated sense of self worth a boastful egotist is not necessarily a self absorbed egoist hysterical find too much sig in things, depressed find to little

lie

false statement that a person makes in order to deliberately deceive another person, everyday lyings (almost eveyrone lies on occasion) compulsive liars ( some ppl consistently lie out of habit even when nothing is gained by the lies) sociopathic liars ( lie incessantly, without any concern for others, in order to get their way) compulsive and sociopathic are often referred to collectively as pathological lying (common feature in antisocial, borderline, histrionic, and narcissistic brain's prefrontal cortex becomes more active when lying polygraphs and fMRI's (how they observe lies) can be fooled most lie in phone calls and to parents READ 557

better ways to classify personality disorders

hard to diagnose and easy to misdiagnose may have serious validity and reliability w categories -some criteria cannot be observed directly, ex schizoid vs paranoid clinicians must ask whether ppl avoid forming close relationships and why, rely heavily on impressions of clinician - clinicians differ widely in their judgments about when a normal personality style crosses the line and deserves to be called a disorder some dont want to call personality styles a disorder ever -personality disorders are often very similar to one another, can meet criteria for several dsm5 categories -ppl w quite df personalities may qualify for the same DSM5 personality disorder diagnosis main problem: categories instead of dimensions of personality more say it differs more in degree than in type of dysfunction be diagnosed for severity of key personality traits (dimensions) rather than presence or absence of specific traits traits would be varying along a continum in which there is no clear boundary between normal and abnormal ppl w personality disorder would be those who display extreme degrees of several of key traits, not commonly found in general population some think you should use big 5 as key traits

PDTS continued

if person is impaired significantly by any of the five trait groups or even by 1 of the 25 traits that make up the groups, they would qualify for a personality-trait specified diagnosis indicate which traits are impaired, special note of impairment in areas functioning like identity ( self esteem, self-other boundaries), self dirction (pursuit of goals, constructive standards), empathy ( appreciation of others experiences and needs), intimacy ( connection w others) ex dependent personality, greatly impaired by neg affectivity group disorder like: personality disorder- trait specified, w problematic traits of separation insecurity, anxiousness, submissiveness, and depressivity must also rate dysfunction caused by traits on 5 point scale, 0 w no impairment, 4 as extreme imparment not accepted w everyone bc believe that changes would give too much latitude to diagnosticians, allowing them to apply diagnoses of personality disorder to an enormous range of personality patterns others worry that requirements are too cumbersome or complicated, too difficult to use time and research will tell

in late victorian era many english parents believed babies absorbed personality and moral uprightness as they took in milk thus if a mother couldn't milk it was important to find a wet nurse of good character

in 1938 the term borderline was introduced by psychoanalyst adolph stern, he used it to describe patients who were more disturbed than neurotic patients, yet not psychotic, has evolved into present usage only 23% of adults openly express their anger 39% say they hide or contain their anger, 23% walk away to try to collect themselves contrary to the notion that letting off steam reduces anger, angry participants in one study acted much more aggressively after hitting a punching bag than did angry ppl who sat quietly for a while

symptoms of personality disorders

last for years and typically become recognizable in adolescence or early adulthood, although some start in childhood most difficult psychological disorders to treat no even aware of their personality problems and fail to trace their difficulties to their maladaptive style of thinking and behaving 10-15% of all adults in us have personality disorder

narcissistic personality disorder

marked by a broad pattern of grandiosity, need for admiration, and lack of empathy convinced of their own great success, power, or beauty they expect constant attention and admiration greek myth , narcissus died enraptured by the beauty of his own reflection in a pool, pining away w longing to possess his own image his name came to be synonymous w extreme self involvement, and grandiose sense of self importance exaggerate achievements and talents, expecting others to recognize them as superior, and often appear arrogant choosy about their friends and associates their problems are unique and can be appreaciated only by other special high status ppl have charm and make a favorable first impression, yet they can rarely maintain long term relationships seldom interested in feelings of others not even able to empathize w such feelings many take advantage of other ppl to achieve their own ends, perhaps partly out of envy, at the same time they believe others envy them some react to criticism or frustration w bouts of rage, humiliation, or embitterment and some react w indifference extremely pessimistic and filled w depression many periods of zest that alternate w periods of disappointment 6.2% of adults, 75% are men these types of behaviors and thoughts are common and normal among teenagers and do not usually lead to adult narcissism

obsessive compulsive personality disorder

marked w intense focus on orderliness perfectionism, and control that the person loses flexibility openness and efficiency doing everything "right" impairs productivity concern w rules and order and doing things right makes it hard for him to see the big pitcure when given task they become so focused on organizaiton details that they fail to grasp the point of the activity, work is often late, some cant finish job, and they may neglect leisure activities and friendships unreseaonably high standards for themselves and others, well beyond realm of conscientiousness never satisfied w performance, but normally refuse to seek help or do work w team bc others are careless and incompetent to do the job right reluctant to make decisions bc they are afraid of making mistakes tend to be rigid and stubborn, particularly in morals, ethics, and values strict personal code and measure others w it trouble expressing affection and relationships are stiff and superficial stingy w time and money and cannot throw out objects that are worn out or useless 7.9% of adult pop white educated married and employed ppl receiving diagnosis the most men twice as likely as women this and obsessive compulsive disorder are closely related/share alot of features/most meet criteria for either/ ppl w the personality disorder are more likely to suffer from major depressive disorder, generalized disorder or substance use disorder than regular disorder/ no consistent link between the two OCD ppl typically do not want or like the symptoms, ppl w OCPD often embrace their symptoms and rarely wish to resist them

women are 2.5 times more likely than men to turn to food as a way to calm down when angry

men are 3x more likely than women to use sex as a way to calm down when angry women are 56% more likely than men to yell alot when angry men are 35% more likely than women to seethe quietly when angry

treatments for histrionic

more likely to seek treatment on their own working w them can be difficult bc their demands, tantrums, and seductiveness are likely to deploy clients may pretend to have important insights or to change during treatment merely to please the therapist therapists must remain objective and maintain strict professional boundaries bc of this cog therapists have tried to help ppl w disorder change their belief that they are helpless and also to develop better, more deliverate ways of thinking and solving problems psychodynamic therapy and group therapy have also been used in all approaches, therapists aim to help clients recognize their excessive dependency, find inner satisfaction, and become more self reliant each approach can be useful drug therapy appears less successful expect as relieving depressive symptoms some patients have

treatments for narcissitic

most difficult to treat bc clients are unable to acknowledge weaknesses to appreciate the effect of their behavior on others or to incorporate feedback from others mostly treat bc related disorder like depression in treatment, these ppl may try to manipulate therapist into supporting their sense of superiority and some seem to project their grandiose attitudes onto their therapists and develop a love hate stance w them -psychodynamic seek to help ppl w disorder recognize and work through their basic insecurities and defenses -cog focus on self centered thinking of such individuals, trying to redirect clients focus onto opinions of others, to interpret criticism more rationally, increase their ability to empathize, and change their all or nothing notions no approaches have had clear success

explain obsessive compulsive personality disorder

mostly borrowed explanations from the disorder despite no link between them -psychodynamic dominate and research evidence is limited ppl w this are anal retentive bc overly harsh toilet training during the anal stage filled them w anger and they became fixated at this stage, to keep anger under control they persistently resist both teir anger and their instincts to have bowel movements, become extremely orderly and restrained, others say early struggles w parents over control and independence may ignite the aggressive impulses at the root of this disorder -cog have little to say but say illogical thinking processes maintains disorder dichotomous thinking produces rigidity and perfectionism misread or exaggerate the potential outcomes of mistakes or errors

treatment OCPD

normally dont think there is anything wrong w them not likely to seek treatment unless suffering from other disorder (most likely anxiety disorder or depression) or unless someone close to them pushes them to get treatment therapists feel they have to win over and engage the clients in the therapy process respond well to psychodynamic or cog therapy -psychodynamic try to help clients recognize, experience, and accept underlying feelings and insecurities and perhaps take risks and accept their personal limitations -cog change their dichtomous all or nothing thinking, perfectionism, indecisiveness, procrastination, and chronic worrying ppl w OCPD like those w OCD respond well to ssri's the serotonin enhancing antidepressant drugs but needs more research

histrionic personality disorder

or hysterical personality disorder characterized by a pattern of excessive emotionality and attention seeking extremely emotional, emotionally charges, need to be center of attention exaggerated moods and neediness always on stage using theatrical gestures and mannerisms and grandiose lnaguage to describe ordinary evveryday events change themselves to attract and impress an audience, change not just surface characteristics but also opinions and beliefs speech is actually scanty in detail and substance and lack a sense of who they actually are approval and praise are very important, must have others present to witness their exaggerated emotional states vain, self centered, demanding, unable to delay gratification for long, they overreact to any minor event that gets in the way of their need for attention some make suicide attempts, most often to manipulate ppl exaggerate physical illnesses or fatigues, behave very provocatively and try to achieve their goals through sexual seduction most obsess over how they look andhow others will perceive them exaggerate the depth of relationships, considering themselves to be intimate friends of ppl who see them no more than acquaintances often get involved w romantic partners who are exciting but dont treat them well 1.8% of adults males and females equally affected (used to think it was more women like the hysterical wife) many clinicians in several studies gave a diagnosis of histrionic personalit disorder to women more than men

odd personality disorders

paranoid, schizoid, schizotyhpal odd or eccentric behaviors that are similar but not as extensive of schiz extreme suspiciousness, social withdrawal, peculiar ways of thinking and perceiving things leave person isolated related to schiz maybe ex schizotypal listed twice in dsm5 under schizophrenia spectrum disorders and a personality disorder often qualify for schiz or have close relatives w schiz learned alot about symptoms but not determining causes or treatments rarely seek treatment anyways

personality traits

particular characteristics, lead us to react in fairly predictable ways as we move through life flexible when we learn from experience ppl w personality disorder do not usually have flexibility

schizoid personality disorder

personality disorder characterized by persistent avoidance of social relationships and little expression of emotion, no close ties to ppl, not bc of suspicion like paranoid but genuinely prefer to be alone loners no efforts to start or keep friendships, take little interest in having sexual relationships, indifferent to their families seek out jobs that require little or no contact w others can form work relations to a degree if needed, but prefer to keep to themselves, live by themselves mostly social skills are weak if they get married, lack of interest in intimacy may create marital or family problems focus mainly on themselves and are generally unaffected by praise or criticism, rarely show feelings, neither joy nor anger, no need for attention or acceptance typically cold, humorless, or dull, succeed in being ignored 3.1% of adult population, men more likely to have it and may also be more impaired by it explaining: psychodynamic theorists (particularly object relations)- roots in an unsatisfied need for human contact, parents may be unaccepting or abusive of their children like in paranoid paranoid ppl react to parenting w distrust, schizoid reacts by being unable to give or receive love and cope by avoiding all relationships cognitive theorists- ppl w schizoid suffer from deficienceies in their thinking, thoughts tend to be vague, empty, and without much meaning, and have trouble scanning the environment to arrive at accurate perceptions. unable to pick up emotional cues from others, they cant respond to emotions, develop language and motor skills very slowly, whatever their intelligence is treatment: social withdrawals prevents them from entering therapy unless another disorder like alcoholism makes treatment necessary remain emotionallly distant from therapist, dont care about own treatment, make limited progress at best cog beh- sometimes able to help them experience more positive emotions and more satisfying social interactions, cog side includes presenting clients w lists of emotions to think about or having them write down and remember pleasurable experiences, beg side has some success w teaching social skills to clients, role playing, exposure techniques, and homework assignments as tools group therapy- apparently useful when it offers a safe setting for social contact, may resist pressure to take part drug therapy offers limited help

treatments for dependent

place all responsibility for treatment and well being on clinician key task is to help patients accept responsibility for themselves some suggest couple or family therapy or even separate therapy for partner or parent bc domineering behaviors of others may foster patients symptoms treatment at least modestly helpful -psychodynamic focuses on many of the same issue for depressed ppl including transference of dependency needs onto the therapist -cog beh help the clients take control of their lives, beh end provides assertiveness training to help the individuals better express their own wishes in relationships , cog end helps them challenge and change their assumptions of incompetence and helplessness -antidepressants are helpful if ppl w dependent personality disorder also have depression -group therapy can be helpful like it is in avoidant bc it provides opportunities for client to receive support from number of peers rather than one single dominant person and group members may serve as models for one another as they practice better ways to express feelings and solve problems

mass killings

psychologists dont have enough research or effective interventions for this yet killing of 4 or more ppl in same location at around the same time on average mass killings occur in us every 2 weeks, 75% involve 1 killer, 67% involve use of guns, most are committed by men number of mass killings is not on the rise overall certain kinds of mass killings are increasing though pseudocommando mass murders for example are on the rise-"kills in public place during the daytime, plans his offense in advance and comes prepared w a powerful arsenal of weapens, no escape planned and expects to be killed during the incident" also autogenetic (self generated) massacres are rising- where individuals kill ppl indiscriminately to fulfill a personal agenda number of factors to explain autogenetic, pseudocommando and other mass killings: availability of guns, bullying behavior, substance abuse, proliferation of violent media and video games, dysfunctional homes, contagion effects and mental illness most suffer from mental disorder (which one has little agreement but these are most likely): antisocial, borderline, paranoid, schizotypal, schiz or severe bipolar, intermitent explosive disorder (impulse control disorder featuring repeated unprovoked verbal and or behavioral outbursts, severe mood stress or anxiety disorder none have received clear support several variables emerged: severe feelings of anger and resentment, feelings of being persecuted or grossly mistreated, desires for revenge, mostly driven by set of feelings should focus less on diagnosis but more on identifying and understanding these particular feelings many mass murders survive their crimes

antisocial personality disorder

psychopaths or sociopaths marked by a general pattern of disregard for and violation of other ppl's rights most closely linked to adult criminal behavior after substance use disorder at least 18 yrs old, most ppl display antisocial patterns of misbehavior before they turn 15 including truancy, running away, cruelty to animals or ppl, and destroying property was referred to as moral insanity during the nineteenth century lie repeatedly cannot work consistently at a job, they are frequently absent and are likely to quit their jobs altogether, careless w money and frequently fail to pay their debts often impulsive, taking action without thinking of the consequences may be irritable, aggressive, and quick to start fights, many travel from place to place recklessness is common trait- little regard for their own safety or of others even their children, self centered and are likely to have trouble maintaining close relationships , have a knack for gaining personal profit at expense of other ppl bc the pain or damage they cause seldom concerns them, lack a moral conscience think their victims are weak and deserve to be conned, robbed or physically harmed 3.6% of adults meet criteria, 4x more common in men than women often arrested so researchers often look for them in prison '40% of ppl in prison meet criteria for men, linked strongly to past arrests for crimes of violence criminal behavior declines after age of 40 but some continue it throughout their lives have higher rates of alcholism and substance abuse disorders (help trigger development of disorder maybe by loosening a person's inhibitions) or may make someone more prone to abuse substances or they might both have the same cause such as a need to take risks drug users w personality disorder often cite the recreational aspects of drug use as reason for starting and continuing it children w conduct disorder and an accompanying attention deficit/hyperactivity disorder have a heightened risk of developing antisocial personality disorder (often bear similarities to antisocial disorder) these children lie and violate rules and other ppl's rights, and children w attention deficit/hyperactivity lack foresight and judgement and fail to learn from experience like antisocial connection between childhood disorders and antisocial disorder has been difficult to pinpoint

hate crimes

racial ethnic groups-4119 incidents reported lgbt-1318 religious groups- 1166 groups w disability- 102 some cultures more antisocial like new zealand, australia, us not in mexico, sweden or korea

DBT created by linehan

who had borderline herself would include day to day skills behavioral therapies w added elemens like opposite action in which patients act opposite to the way they feel when an emotion is inapproriate and mindfulness meditation ppl on this treatment had far less suicide atempts, landed in hospital less often and more likely to stay in treatment used for a variety of clients even juvenile offenders